The History and Regulation of EHRs ASCA is working with the government to create an ASC-specific certification BY ALEX TAIRA

In recent years, health information technology (HIT) has been the talk of the health care industry. Central to this discussion

are products known as electronic health records (EHRs), systems that electron- ically capture patient-provider encoun- ter information, securely store the dig- ital information and make it available for future reference. The potential benefits of such a system are bound- less: streamlined provider workflows, increased information sharing across sites of service, reduction in medical errors, increased patient access to their health record, better medication track- ing and more. Developing and imple- menting tailored, functional EHRs, however, has been a rocky road even for those with time and resources. It

is no surprise then that EHR

uptake in the ASC community has been tentative; small facilities rightly regard lengthy, costly projects with a wary eye. It would be a mistake for ASCs, however, to disregard EHRs entirely, as both the industry at large and regulatory forces are increasingly marshalling to push all sites of service toward adopting HIT.

The Beginning of the Modern EHR The history of capturing patient health information electronically goes back to the 1960s when a number of universi- ties and corporations worked to develop “clinical information systems.” The federal government wasn’t far behind; the Veterans Administration deployed a complete medical information system in 1978, the precursor to the Depart- ment of Veteran’s Affairs (VA) VistA or Veterans Health Information System and Technology Architecture, a widely lauded EHR still in use today.

Increasing Conversation: Asserting Benefits and Refining Specs With early EHR frameworks in place, the 1980s and 1990s saw interest in EHR spread throughout the industry. In 1991, the Institute of Medicine (IOM) published study results that identified EHRs as a key recommendation for improving patient records. Meanwhile, a group of academics, informaticists, vendors and consultants had begun dis- cussing a set of international standards governing the transfer of clinical and administrative data. This group, which would establish as Health Level Seven International (HL7) in 1987, remains instrumental in developing standards for data transfer between health care information systems. By 2003 all the pieces were in place and the Depart- ment of Health and Human Services (HHS) and the VA approached HL7 to ask about accelerating work toward

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refined EHR model standards. In April 2004 President George W. Bush announced $100 million in funding for HIT projects as part of a larger effort toward widespread EHR adoption by 2014. He created a new sub-cabinet position, the national health informa- tion coordinator, today’s Office of the National Coordinator (ONC).

The Modern Era: HITECH, Meaningful Use, CEHRT and MACRA President Obama followed quickly in President Bush’s footsteps. Part of 2009’s American Recovery and Rein- vestment Act (ARRA), the Health Infor- mation Technology for Economic and Clinical Health (HITECH) Act carved out $25.9 billion for the promotion and proliferation of HIT. The HITECH Act was the federal government’s entry into the HIT world, one that sent HIT busi- ness through the stratosphere and laid

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